The safety of newborn early discharge: The Washington State experience

Lenna L. Liu, Conrad J Clemens, David K. Shay, Robert L. Davis, Alvin H. Novack

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Context. - While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established. Objective. - To assess the risk for rehospitalization following newborn early discharge. Design. - Population-based, case-control study. Setting. - Washington State linked birth certificate and hospital discharge abstract covering 310 578 live births from 1991 through 1994. Patients. - Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included. Main Outcome Measure. - Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth). Results. - Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR, 1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1,91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis. Conclusion. - Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.

Original languageEnglish (US)
Pages (from-to)293-298
Number of pages6
JournalJournal of the American Medical Association
Volume278
Issue number4
StatePublished - Jul 23 1997
Externally publishedYes

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Newborn Infant
Safety
Odds Ratio
Parturition
Confidence Intervals
Mothers
Multiple Birth Offspring
Birth Certificates
Live Birth
Jaundice
Dehydration
Case-Control Studies
Rupture
Sepsis
Logistic Models
Outcome Assessment (Health Care)
Pregnancy
Membranes
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The safety of newborn early discharge : The Washington State experience. / Liu, Lenna L.; Clemens, Conrad J; Shay, David K.; Davis, Robert L.; Novack, Alvin H.

In: Journal of the American Medical Association, Vol. 278, No. 4, 23.07.1997, p. 293-298.

Research output: Contribution to journalArticle

Liu, Lenna L. ; Clemens, Conrad J ; Shay, David K. ; Davis, Robert L. ; Novack, Alvin H. / The safety of newborn early discharge : The Washington State experience. In: Journal of the American Medical Association. 1997 ; Vol. 278, No. 4. pp. 293-298.
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abstract = "Context. - While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established. Objective. - To assess the risk for rehospitalization following newborn early discharge. Design. - Population-based, case-control study. Setting. - Washington State linked birth certificate and hospital discharge abstract covering 310 578 live births from 1991 through 1994. Patients. - Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included. Main Outcome Measure. - Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth). Results. - Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95{\%} confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95{\%} CI, 1.03-1.32), and 28 days (OR, 1.12; 95{\%} CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR, 1.25; 95{\%} CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95{\%} CI, 0.79-1,91), and mothers with premature rupture of membranes (OR, 1.41; 95{\%} CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis. Conclusion. - Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.",
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